Ownership and use of insecticide-treated nets during pregnancy in sub-Saharan Africa: a review

Abstract

Over the past decade, significant gains have been made in the implementation of malaria prevention measures in pregnancy in sub-Saharan Africa, including the distribution of insecticide-treated nets (ITNs). These have been shown to cause a reduction in the incidence of malaria and its consequences such as maternal anaemia, stillbirths and intrauterine growth restriction. Currently most nations in Africa have policies for distributing ITNs to pregnant women through various mechanisms, however coverage remains well below the targets. This review summarizes recent evidence regarding the correlation between ownership and use of ITNs and the determinants of both, in pregnancy in sub-Saharan Africa, and reviews interventions directed at improving coverage. A review of the literature using Pubmed, CINAHL and scanning of reference lists was conducted in October 2012 and 59 articles were selected for final review. The research obtained was a mixture of national and district level surveys, and a narrative synthesis of the data was undertaken. Ownership of ITNs varied from as low as 3% to greater than 80%, and the main determinants were found to be education level, knowledge of malaria, community involvement, socio-economic status and parity, although the significance of each varied between the different settings and studies reviewed. In more than half the settings where data were available, the combination of lack of availability and lack of use of an available net meant that less than half of all pregnancies received the recommended intervention. Supply and cost remain major barriers to achieving optimal coverage, but the additional important contributor to reduced efficiency of intervention was the clear discrepancy between ownership and use, with available ITN use below 60% in several settings. Cited reasons for not using an ITN, where one was available, included discomfort, problems with hanging up nets and lack of space, low awareness of need, and seasonal variations in use. These findings highlight the need for context-specific approaches and educational components to be incorporated into ITN distribution programmes to address some of the reasons why some pregnant women do not use the ITNs they own.

LLIN Ownership, Utilization, and Malaria Prevalence: An Outlook at the 2015 Nigeria Malaria Indicator Survey

“…This study, which critically examined the correlation between LLINs use and malaria prevalence in only adequate education and knowledge on malaria and ITNs/LLINs, but also on household income, socio-economic status and whether residing in urban areas [19]. Equally, in studies conducted in Nigeria and Uganda, results showed a low level of education as a factor to higher rates of ITN use [20] [21].…”

Insecticide Treated Nets Usage and Barriers Among PregnantWomen Attending Ante-Natal Clinic in Ogun State, Nigeria

“…Also, it has influenced increased incidence of anemia and spontaneous abortions, intrauterine growth restriction [IUGR], stillbirths, fetal distress and congenital malaria. These have placed pregnant women as a highly vulnerable group to malaria infection thus they need to be protected (Auta, 2012; Singh et al, 2013;Ankomah et al, 2012). The severity of malaria is worsened by pregnancy as a result of distinct malarial parasites that bind to the placenta.…”

Paludisme et anémie des enfants en Afrique subsaharienne : effet de la distribution de moustiquaires

“…Or notre variable de mise à l'échelle mesure la distribution. Notez que des travaux ont bien souligné que la possession de moustiquaires n'entraîne pas forcément leur utilisation (Singh et al [2013] …”